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Site Number C g Date <br /> Tm�tic-C STF9tunP Sensor :» F Il Tp I t Sernor � '� '' rat fJte��rtimr la for <br /> Ortfer per Write In Manutseturer&Model No. <br /> tank LINK=Present but can't determine <br /> monitor NA=No Sensor <br /> 1 /AloA1P_ -19Q 3 b0 -- -7 0 A <br /> Irl t43 Pi Q — 3 v /� <br /> 4 <br /> 5 <br /> e <br /> R � <br /> Itfodel rhrt rber Be"Nmber 1(jo" mawl Date No.of X..w�No.of lleeere 13tend rv;m D16pmtser uglded tv sye6ama <br /> valences-,, <br /> B=Bennett Write number Write number Lighted TV Systems <br /> 12 or 3,4, G=Gdbaroo Write m the year M-Mechanical Valances on integrated in <br /> Write in Model Number W rile in Sena!Number the dispenser xas of noelin per of meters per E=Eiectrorric P Pressure <br /> etc W=Wayne fueling fueling S=Suction Dspensers9 dispensers? <br /> T=Tokheun rrateded NA=None <br /> position posltlon <br /> Yes or No Yes or No <br /> A f <br /> 61 /dial f eA o. 0 Y1 <br /> 'A' Myl 10-77 � 2 <br /> VO 76, <br /> G� <br /> fj <br /> ATAL <br /> Comments on any damagedroefective equipment_ <br /> EN Cove <br /> issued 12/27/2017 Page 5 of 10 <br />